Want the pandemic to end? Don’t fight over COVID-19 vaccine like we did over masks

This week was a cause for celebration in Idaho and across the United States, as the first shipments of the COVID-19 vaccine began to arrive at hospitals.

This is the moment we’ve all been waiting for, right? The solution to the pandemic. The magic bullet to get us all immune to the coronavirus. The end is in sight. We can see the light at the end of the tunnel.

Of course, not all is rosy. Why would it be? Not in our day and age of conspiracy theories, social media disinformation and the politicization of what should be accepted science.

Unfortunately, we have to temper our enthusiasm over the arrival of the vaccine with the realization that some people — who knows how many — will not get it, for a variety of reasons, whether it’s anti-vaccine sentiments in general, skepticism over the rapid development and production of a new type of vaccine, or some off-the-wall conspiracy theory involving Bill Gates and microchips.

But if we want to get back to normal — as everyone wants to do — it’s going to require as many people as possible to be vaccinated.

“We need to assure our patients that any vaccine, once approved, is not only safe and effective, but that it’s undergone the rigorous review required before being made available to the public,” American Medical Association President Dr. Susan Bailey said Monday during a webinar for journalists reporting on the vaccine.

Dr. Anthony Fauci said Tuesday that 75% to 85% of the population would need to get the vaccine to achieve “herd immunity,” which is the level of protection for those members of the population who either won’t or can’t get it.

Polls on people willing to get the vaccine are all over the map, with one Pew Research Center poll in September showing only 51% of Americans would definitely or probably get the vaccine. More recent polls, though, are showing promise, with acceptance rates as high as 84%.

In Idaho, many residents view vaccinations with suspicion, and the state is near the bottom compared with other states for rates of flu vaccinations, according to The Associated Press. About 50% of children 6 months to 17 years old in Idaho got a flu shot last winter, the third-lowest rate in the nation, according to the U.S. Centers for Disease Control and Prevention. Among adults, only about 41% got flu shots, putting Idaho ninth from the bottom.

“Here is the nightmarish scenario — that we have a safe and highly effective COVID-19 vaccine … and then because distrust is so high and lack of confidence is so high, no one wants to take it, and that is just not going to be acceptable,” Dr. Howard Koh, former assistant secretary for health for the U.S. Department of Health and Human Services, told the Boston Herald.

If Americans don’t trust the vaccine and choose not to get it, “this pandemic is going to go on indefinitely,” Koh said.

There’s plenty of reason for concern. But Dr. David Pate, retired CEO of St. Luke’s Health System, said he remains “realistically optimistic.”

“I actually think this is not going to be the problem we fear it will be with people getting vaccinated,” he told me in a phone interview.

For one, as more and more people get COVID-19, more and more people will know someone who has had it, has had serious complications from it or has died because of it, and that might sway people to get the vaccine.

Unlike, say, measles or mumps, which are somewhat more intangible, COVID-19 is an immediate, tangible threat outside your door.

Next, Pate points out that the COVID-19 vaccine is free, taking away any cost barrier. Medical providers can still charge for administering the shot, according to the CDC, but those bills may be covered by insurance or, for uninsured patients, by a federal fund.

Third, he thinks there’s a growing, widespread recognition that life will not return to normal if we don’t get enough people vaccinated.

Pate discounts earlier polls showing low acceptance rates because at the time, the vaccine was not yet a reality. Now it is. More people will see their doctor or neighbor or family member getting it, and will see that it’s safe and effective.

Finally, Pate suspects that people who do not get the vaccine might be prevented from doing some things, such as traveling to other cities, states or countries. Private employers, insurance companies, sporting venues and other private businesses might require you to get a vaccine.

So what levels do we need to get to achieve herd immunity or at least get out of the pandemic?

Pate doesn’t think we’ll necessarily be looking at the percentage of people who have received the vaccine. Those ranges vary widely, and no one is certain what the exact percentage would need to be.

Pate thinks we’ll be looking more closely at our new case rate per day per 100,000 people as a benchmark for when we can declare victory over the coronavirus.

Idaho’s moving seven-day average of new cases per day was right around 94 per 100,000 people, according to data compiled by the Brown School of Public Health data.

“By anyone’s criteria, that is extremely high,” Pate said.

Some measures consider 25 new cases per 100,000 people a “tipping point” for uncontrolled community spread. Pate thinks as people get vaccinated, we should see the new case number start to go down.

But we have a long way to go.

“I’m guessing that when that number of average new cases per day per 100,000 gets down in the range below three, that’s probably when we will say we’ve really got this under good control, we’re probably achieving some semblance of herd immunity,” Pate said. “And that’s probably the point where we can start saying we can relax our restrictions.”

Vaccine rollout

The first doses of the vaccine are now being given to the highest priority people: health care workers and residents of long-term care facilities. Skilled nurses and those working in assisted living and intermediate care facilities are counted as health care workers in this phase, according to the Idaho Department of Health and Welfare.

After that, the state’s Coronavirus Vaccine Advisory Committee is recommending that the next phase of the vaccination plan include essential workers who were not part of the first phase.

That includes:

• First responders, including fire, police, protective services and community support personnel.
• Pre-K-12 school staff and teachers, and day-care workers
• Correctional and detention facility staff, except medical staff already in the first phase
• Food processing workers
• Grocery and convenience store workers
• Idaho National Guard
• Other essential workers unable to telework or social distance at work

Assuming production continues at its current pace, the vaccine will be rolled out to the general public over the next few months.

It’s still too early to know exact timelines for rollout to the general public, Brandon Atkins, public information specialist for Central District Health, told me by phone Thursday. When vaccines become readily available for the general public will depend on vaccine production, how many doses get shipped to Idaho and when and the number of people who decide to get the vaccine, all of which still remains to be seen.

Here’s the deal. Even if you want to roll the dice yourself, take the chance that either you won’t get COVID-19 or it won’t kill you, you should still get the vaccine so that we can control the spread in the community and avoid further overwhelming our health care system.

As I’ve written before, the coronavirus is more stealthy, more contagious and more deadly than other viruses, such as seasonal flu or even the swine flu.

People can carry coronavirus and spread it for a longer period of time without symptoms, and the effects of COVID-19 are more serious and more lethal.

Even if you want to play craps with your own health by skipping the vaccine, you’re putting someone else’s life at risk, with the potential of being a carrier and spreading it.

Here is some helpful information on the vaccine as we head into 2021.

If I already had COVID-19, should I still get the vaccine?

The short answer is yes. Dr. Christine Hahn, Idaho’s state epidemiologist, said during a Facebook Live session last week that immunity from COVID-19 among those who have already had the disease seems to last about 90 days or so, but the disease hasn’t been around long enough to track cases to be certain. So the safe bet is to get vaccinated if it’s been more than 90 days since you’ve had COVID-19. Hahn said if you’ve had COVID-19 recently, you might wait those 90 days before getting it.

Are we going to need to get a COVID-19 vaccine every year, like the flu?

“We are also waiting for a recommendation on that,” Pate said. “Most of us believe that the ultimate recommendation will be somewhere between once a year and every three years. I haven’t heard any vaccine expert that thinks this is going to be longer-lasting than three years.

“You know, the plain truth is we don’t know. ... What it could be is that early on, until we know, it may be recommended to be annual. It may be that, with more time, we discover that in fact people can go longer in between vaccines.”

If I get the vaccine, can I still spread COVID-19 to others?

The unsatisfying answer is “possibly” or “probably,” so it’s essential to continue wearing a mask and practicing social distancing for the time being, until we have more data.

“We don’t know for sure. Even if you get good immunity from it and you know that you won’t get sick from this disease, you might still be able to carry it and pass it on,” Hahn said. “So it is likely that for a while, and that might be months, even after vaccination is being implemented in the United States, that people will be advised strongly to continue wearing masks, socially distance, do all those things until we get a significant percentage of the population vaccinated.”

Are all of the vaccines two doses?

Moderna and Pfizer vaccines are two doses. Other vaccines are in the pipeline that have just one dose.

For double doses, how far apart are they taken?

For Moderna, 28 days apart. For Pfizer, 21 days, according to Sarah Leeds, immunization program manager with the Idaho Department of Health and Welfare.

Leeds said there is concern that people may take the first dose but then not come back for the second, something health officials want to avoid. Hahn said there appears to be some limited immunity with one dose, but ideally both doses should be taken.

It’s also important to take the same vaccine both times. If you get the Moderna vaccine in the first dose, you need to get the Moderna vaccine with the second dose, said Dr. Paul Offit, a pediatrician specializing in infectious diseases, vaccines, immunology, and virology at Children’s Hospital of Philadelphia.

“They are not interchangeable,” Offit said during the Poynter Institute webinar for journalists covering the vaccine. “So if you’ve got one you then can’t just get your second dose with the other.”

Does it matter which one I get? Is one better than the other?

The short answer is “no,” according to Offit. That said, he added that as other vaccines come along, we may discover that certain vaccines might be better for certain populations, but “right now, you’ve establish the standard with these two vaccines with an efficacy that’s extremely high. It’s going to be hard to top that.”

Are multiple doses of vaccines common?

Yes. Many vaccines that we already take have multiple doses or booster doses, such as shingles, hepatitis B and most pediatric vaccines, according to Leeds.

Are there side effects?

Patsy Stinchfield, a pediatric nurse practitioner in infectious disease at Minnesota Children’s Hospital, spoke Monday during the Poynter webinar, said this about side effects:

“Here’s what you should expect. You should expect that your arm may be sore, you should expect that you maybe have some feeling of fatigue or muscle aches and you may have some fever, you may have some headache. Those things are to be expected, and what is happening is your immune system is responding. It sees the bad guy, it’s making the good guys, and that sort of feeling of that there’s something happening in your body is to be expected. ... It usually lasts about a day. And it is far, far, far better than having COVID disease.”

What about allergic reactions?

Two health care workers in Alaska experienced allergic reactions to the vaccine, one serious but non-life-threatening and one not serious. Allergic reactions have been expected, as three people experienced allergic reactions during clinical trials.

“The CDC recommendation is that if you have ever had a severe allergic reaction to an injectable product, that you not get this vaccine,” Offit said. “Otherwise, so for example people commonly have peanut allergies or egg allergies or other food allergies that you still can get this vaccine, you just need to wait for 30 minutes in the area there where you’ve gotten that vaccine, so that if you do have an allergic reaction, somebody would be able to give you a shot of epinephrine to reverse it. And that for everybody else, we make a recommendation that we always make for vaccines, which is that whenever you get a vaccine, you should hang around for about 15 minutes to make sure you didn’t have this allergic reaction.”

How soon after taking the vaccine is it effective?

The Pfizer vaccine has an efficacy rate of 95% seven days after the second dose, Leeds said.

Will the vaccine be free to everyone?

Yes. The vaccine, itself, is free, through the White House Coronavirus Task Force’s Operation Warp Speed program, Leeds said. Clinics are allowed to charge a fee to administer the vaccine, but it should be nominal and in most cases should be covered by insurance, Leeds said. If not, federal money is available to cover the cost, so that cost is never a barrier for anyone to get the vaccine.

This vaccine is an mRNA vaccine. What does that mean? What is mRNA? Is it new? How does it work?

Offit explained it this way: “Messenger RNA is something we all have in our bodies. It’s that small piece of genetic material that is in the cytoplasm of our cells. It sort of instructs the cell to make a protein, and our cells make proteins all the time, so it’s not a novel molecule, it isn’t something we haven’t seen before. We all have messenger RNA in our bodies.

“And frankly it’s not a novel strategy. This particular notion of using messenger RNA as a vaccine has been around for 20 years. People have been working on messenger RNA vaccines against human immunodeficiency virus, malaria, tuberculosis, Ebola, Zika, etc., so this is just the first crack to sort of get above the water to become a commercial product.

“The way it works is that normally when you’re given a vaccine, like you’re interested in inducing an immune response of a viral protein, in this case the protein you’re interested in is that protein that sort of emanates from the surface of the virus — that spike protein. If you can make antibodies to that spike protein, you can prevent the virus from binding to cells.

“So normally we give the protein, we either give it as a purified protein — which is the way say the hepatitis B vaccine is made or the human papillomavirus vaccine is made — where we give it like as part of a live attenuated virus or killed virus.

“What’s different about this (mRNA) strategy is you’re not giving the protein. What you’re doing is when you’re giving this (vaccine), you’re giving the genetic material that teaches your cells to make that protein. That’s the difference. So your body makes the spike protein of coronavirus, then your body makes antibodies to the spike protein. So that’s the critical difference.”

How will the vaccine get distributed to the general population? How will I know it’s my turn?

Hahn and Leeds said details of how the vaccine will be rolled out to the general public are still being worked out, but it will be managed through each local public health district in coordination with health care providers.

Information on vaccine availability will be well-publicized, though, Leeds and Hahn said, and individuals should stay in contact with their primary care provider to see when they can get the vaccine.

The state is also making available a clinic management tool to help providers schedule vaccination appointments and efficiently manage the vaccine and mass vaccinations.

Leeds and Hahn stressed that the rollout may look different in different parts of the state, based on availability and numbers of health care workers, for example, or high-risk individuals that would be first in line to get the vaccine.

Another variable: vaccine uptake, or the number of people who decide to get the vaccine. In other words, if you live in an area where not a lot of people choose to get the vaccine, you likely will get it earlier if you want. If you live in an area where a lot of people are choosing to get the vaccine, your wait might be a little longer.

However, here’s the good news…

How long before we have enough vaccine for everyone who wants one?

If everything stays on track, there should be enough vaccine to cover everyone by May or June, Leeds said.

“At this point ... we think the general public, by spring to summer, will be able to access the vaccine somewhat readily,” Leeds said.

So if we can hang on, continue wearing a mask, limit gatherings, practice social distancing and get the vaccine when it’s your turn, we could start to see a downturn in COVID-19 numbers.

Finally.

This story was originally published December 18, 2020 at 4:00 AM.

Scott McIntosh

Opinion Contributor,

Idaho Statesman

208-377-6202

Scott McIntosh is the Idaho Statesman opinion editor. A graduate of Syracuse University, he joined the Statesman in August 2019. He previously was editor of the Idaho Press and the Argus Observer and was the owner and editor of the Kuna Melba News. He has been honored for his editorials and columns as well as his education, business and local government watchdog reporting by the Idaho Press Club and the National Newspaper Association. Sign up for his weekly newsletter, The Idaho Way. Support my work with a digital subscription